Diagnostic Accuracy of Red Cell Distribution Width in Diagnosing Early-Onset Neonatal Sepsis in Term Newborns: Red Cell Distribution Width Accuracy in Early-Onset Neonatal Sepsis

Muhammad Jafar Iqbal; Muhammad Hammad Riaz; Muhammad Zulfiqar Siddiq; Javaria Rasheed; Asim Khurshid

doi:10.54393/pjhs.v6i12.3431

Authors

Muhammad Jafar Iqbal Department of Pediatric Medicine, The Children Hospital, The Institute of Child Health, Multan, Pakistan
Muhammad Hammad Riaz Department of Pediatric Medicine, The Children Hospital, The Institute of Child Health, Multan, Pakistan
Muhammad Zulfiqar Siddiq Department of Pediatric Medicine, The Children Hospital, The Institute of Child Health, Multan, Pakistan
Javaria Rasheed Department of Pediatric Medicine, Nishtar Hospital, Multan, Pakistan
Asim Khurshid Department of Pediatric Medicine, The Children Hospital, The Institute of Child Health, Multan, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i12.3431

Keywords:

Sepsis, Newborn, Erythrocyte Indices, ROC Curve, Red Cell Distribution Width

Abstract

Inflammation in neonatal sepsis triggers cytokine-driven disruption of erythropoiesis, producing a mix of immature and damaged red cells. Objectives: To determine the diagnostic accuracy of RDW for early onset neonatal sepsis (EONS) in term newborns, taking culture-proven EONS as the gold standard. Methods: This prospective validation study was conducted at the Department of Neonatology of Children's Hospital, Institute of Child Health, Multan. A total of 147 term neonates with suspected EONS were enrolled consecutively. Neonates with asphyxia, meconium aspiration, major congenital malformations, or hemolytic disease were excluded. Clinical and laboratory data, including RDW, were collected. Blood, urine, and cerebrospinal fluid cultures were performed as per CLSI guidelines. EONS was confirmed by positive blood culture. A cutoff value of RDW ≥17% was used for labelling EONS. Data were analyzed using SPSS version 25.0, and the diagnostic accuracy of RDW was calculated, taking culture-proven neonatal sepsis as the reference standard. Results: The mean postnatal age was 3.7±1.4 days. The mean RDW was 16.9 ± 1.9%. RDW of ≥17% was observed in 54.4% of the neonates. Culture confirmed EONS was diagnosed in 59.9%. RDW showed sensitivity of 84.1% (95% CI: 74.8-91.0%), specificity of 89.8% (95% CI: 79.2-96.2%), positive predictive value of 92.5%, negative predictive value of 79.1%, and diagnostic accuracy of 86.4%. The area under the ROC curve was 0.87 (95% CI: 0.81 – 0.93, p<0.001). Conclusions: RDW ≥17% demonstrated high diagnostic accuracy as an early predictor of culture-confirmed EONS in term neonates.

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